What´s Acute Paronychia?

The nail is a complex cutaneous structure that consists mainly of the nail matrix, nail plate, nail bed, cuticle (eponychium), and nail folds. The cuticle is an outgrowth of the proximal fold, which is situated between the skin of the digit and the nail plate, providing a waterproof seal from external irritants and pathogens.

Paronychia is as an inflammatory reaction of one or more of the three nail folds, proximal or lateral ones, surrounding finger- or toe-nails. It is most commonly divided into acute and chronic. Acute paronychia lasts by definition less than six weeks and is usually associated with inflammation following minor trauma, while chronic paronychia lasts more than six weeks and may occur either independently or as a result of acute paronychia.

Acute paronychia is most commonly caused by a direct or indirect trauma of the cuticle. Such trauma may be minor and result from usual procedures, such as dishwashing, an injury from a splinter or thorn, onychophagia (nail biting), finger sucking, biting or picking at a hangnail, an ingrown nail, artificial nail application, manicure procedures, or other nail manipulation. This kind of trauma enables bacterial inoculation of the nail and consequential infection, with Staphylococcus aureus being the most common pathogen, although Streptococcus pyogenes, Pseudomonas or Proteus may also cause paronychia. Other anaerobic gram-negative bacteria may also be involved, in case the trauma is exposed to oral flora. Except from bacterial infection, acute paronychia may also occur as a manifestation of other disorders affecting the extremities, such as pemphigus vulgaris.

Acute paronychia is clinically characterised by rapid onset of erythema, oedema, and tenderness of the proximal...

... middle of paper ...

... a comedone extractor, delivering a rapid relief of the pain.12 Another simple technique to drain a paronychial abscess involves lifting the nail fold with the tip of a needle, followed immediately by passive oozing of pus from the nail bed.24 If there is no clear response within few days, deeper surgical incision under local anesthesia (digital nerve block) may be needed.8,10,11 The proximal one third of the nail plate can be removed without initial incisional drainage.8,17,19 The physician should be very careful with complicated infections that can occur in immunosuppressed patients, such patients with diabetes.11,16 Incision and drainage is also contraindicated in patients with herpetic whitlow. In these cases, suppressive therapy with acyclovir 5% ointment or cream or an oral antiviral agent such as acyclovir, famciclovir, or valacyclovir has been proposed.15